Aim: The aim of this project was to ascertain what frequency of vital signs should be used to detect a reaction during blood product administration by applying newly acquired translational research skills with RA faculty facilitation.
Research Question: In individuals receiving a blood transfusion, what frequency of vital signs should be used to monitor for a reaction during blood administration?
Background: Research Academy (RA) fourth cohort sought to answer the clinical question of vital sign frequency associated with blood product transfusion by conducting a literature review, appraisal, and synthesis of current published evidence. The organization located in the southwest part of the United States recorded 51/12,077 (0.422%) transfusion-related adverse reactions in 2017, thus highlighting the importance of identifying evidence to support vital sign frequency to detect transfusion reactions. Initially cohort members were teamed up with a RA faculty member to write different sections of an abstract. Curriculum modification was made to synthesize findings as a group after feedback from RA participants. Synthesis was role-modeled using a research grid and themes emerging from reviewed articles by RA faculty. Active participation by direct care nurses was supported by nurse administrators who saw resourcing RA initiatives as an institutional priority.
Methods: A literature review was conducted using Integrated Research Review (IRR) methodology adapted from Whittemore & Knafle (2006). Databases searched with guidance from a research librarian included CINAHL, Cochrane, Medline, & PubMed. Key search terms were "blood transfusion" AND "vital Signs" as MeSH major word terms. Included were current (<5 years) peer-reviewed articles not limited to English. Consensus was not to include practice guidelines. Forty-one articles were identified leaving 29 articles after duplicates were removed. An additional 17 records were excluded due to not addressing search terms. Twelve full-text articles were assessed for eligibility. Evidence of literature was established through inter-rater reliability. Independent review for level of evidence conducted by RA cohort members (N=6) and RA faculty (N=3) of final article sample (N=12) obtained using IRR methodology. Determination of level of evidence of each article was established through inter-rater reliability. Twelve articles were further narrowed to eight after critical review. RA participants organized literature findings through the use of a research grid independently to organize findings and facilitate synthesis of information. Full-text articles in final sample included four informing clinical implications, four addressing the clinical question, and four were removed due to lack of applicability to answering research question.
Results: Final article sample highlighted the impact of blood transfusion reactions on the respiratory system and pain. Inconsistencies were found in frequency of vital sign monitoring and “vital sign” components in reviewed literature. Vital sign components varied across all studies. Systolic blood pressure, heart rate, and temperature were the only components included in all “vital signs” across manuscripts. Respiratory rate was not always included in “vital signs” to identify transfusion reaction. In addition to not having “vital signs” components consistently applied throughout reviewed studies to allow for metanalysis of findings, the question of frequency of vital signs to detect an adverse reaction was not found.
Implications/Translation: Lack of derangement definitions to identify “abnormal” vital sign components to indicate transfusion reactions prevent triggering blood reaction recognition and interventions by nurses. A paucity of evidence exists to guide how frequently vital signs should be monitored and what components should be included in “vital signs” to identify transfusion reactions. Consistently throughout reviewed literature, vital signs alone were noted to not be enough to detect transfusion-related reactions. Transfusion reaction signs and symptoms include physical findings only detected with an assessment. Current vital sign monitoring at start, 15 minutes after, and at the conclusion of transfusions may not detect delayed reactions or respiratory system impairment, especially if oxygen saturation or respiratory rate are not included in monitored vital signs.